New Brunswick has lost its chance to use testing to get ahead of the spread of COVID-19, says a global-health epidemiologist.
But down the road, testing may help the province return to normalcy.
Dr. Raywat Deonandan, an epidemiologist and an associate professor at the University of Ottawa, said there's a window of time when widespread "military-style" testing can help quell the spread of the novel coronavirus.
Using this strategy, a province could identify anyone — symptomatic or asymptomatic, traveller or non-traveller — who has the virus, isolate them and stop that spread.
But once the chance to test every traveller passes and the disease has arrived, shutting down borders and non-essential businesses, and mandatory self-isolation become the province's best bets to stop the spread.
"It may be too late now. Simple as that," he said.
In New Brunswick, where a state of emergency was called last week, Deonandan said testing has become a way of confirming COVID-19 transmission, tallying cases, predicting rates of hospitalization, and a prompt to test other members of the same household — as opposed to a tool to stop the spread.
"The purpose of testing is to identify people who can spread it," Deonandan said. "The purpose of testing is not to identify people to treat, although that's a nice bonus."
This is because in most cases of COVID-19, the treatment is "simply isolation." Once everyone has been asked to self-isolate, the priority becomes reacting to the number of cases showing up.
New Brunswick had 33 cases as of Thursday evening, almost double the number two days ago.
Last week, Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, said countries should be ramping up testing globally.
"You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don't know who is infected," he said in a briefing.
Deonandan said the World Health Organization's recommendation to "test, test, test" is important in countries that haven't shut down non-essential operations.
"Because in that case, we want to identify the people who are spreading and stop them from spreading," he said. "Now, we're assuming everyone's spreading. Stay put, stop spreading."
Jordan Tustin, communicable disease epidemiology expert at Ryerson University, said both, physical distancing and testing, need to be prioritized.
"At this point, we are just seeing the tip of the iceberg," she said.
"We cannot make evidence-based decisions without understanding the full picture."
But that's while keeping in mind the availability of resources.
New Brunswick can do 600 tests a day, but the province has been doing 200 tests. Soon, the lab at the Dr. Georges–L.–Dumont hospital in Moncton will be able to do 1,000 tests a day.
Tustin said physical distancing, increased testing, isolation and contact tracing "need to work in tandem."
When testing will be crucial again
Deonandan said the province and the nation will have another chance to use testing. Once the country is over the worst of the pandemic, widespread testing could be the ideal way to return to normal life.
It could be done before people attend large gatherings or even before a dental appointment.
"It allows us entry back into society without too much disruption in our lives," he said.
Lowest number of tests
New Brunswick is last among Canadian provinces and territories in the number of tests done per 100,000 residents.
Chief medical health officer Dr. Jennifer Russell said Thursday that if people have symptoms, even if they don't have the travel history, "you must act as though you have COVID-19."
Earlier in the week, Russell said the province is ramping up testing to include people who have travelled not only outside the country but outside the province in the last 14 days. The province has been using national testing standards from the start, she said.
Doctors also have the ability to order a test for a patient who hasn't travelled, if they see symptoms that warrant a referral.
Now, Russell said, the province is looking for community transmission that's not travel-related.On Wednesday, she said testing is still being used to "locate, isolate and stop the spread."
"Once we shift into the knowledge that we have community transmission, we will adapt," she said.
Deonandan said having low testing numbers is only one factor in how well a province is responding to a pandemic. He said it's too early to tell if the province with the highest testing numbers will do best at mitigating the damage caused by COVID-19.
Factors like population density, the rate of international travellers entering the province, and how quickly a shutdown is implemented do matter, he said.
But missing the widespread testing window is one sign of "the failure of the public health infrastructure," he said.
"I think many epidemiologists have been saying for some time that a pandemic of some infectious nature is coming, and we should have learned from SARS to invest heavily in infrastructure to do heavy contact tracing and multiple testing."
He said nationally, "salvation" will come from proper management, leadership, investment and preparation.
"In this case, the technology exists to manage this and that is testing — the leadership is possibly what's lacking," he said.
Russell previously said the province is properly balancing the outcomes it wants with the resources it has, and the province has ample testing capabilities.
"We are expanding our testing capacity and ability," Russell said. "So all the ... testing centres that were opened are all up and running. They are meeting the demand that we have right now."
Depending on doctors to refer for testing
New Brunswick has been directing anyone with symptoms to immediately self-isolate and call 811. Most people who call 811 are only getting tested if they've travelled in the last 14 days. Russell said that's the national criteria they're following and have been using since the first case came to light.
Deonandan said a good middle ground would have been "loosening the criteria," and asking people to go through their family doctors. Doctors have the ability to refer patients for testing even if they don't have a travel history.
Dalhousie University medical professor and Saint John doctor Keith Brunt said delays and issues with 811 have shown how important it is for primary care physicians to meet with patients remotely.
"[Primary care providers], they have the physician-patient relationship that 811 doesn't and was never designed for," he said.
He said there's a billing code for online services that allow doctors to see patients using video chat or phone calls.
Brunt said he doesn't think people should be concerned about the number of tests done in New Brunswick.
He said people who experience symptoms but don't get to be tested should still continue to self-isolate as if they're sick. That's the only way to minimize the amount of time the province is in lockdown.